Revealed: spiralling cost of seven-day GP access

Seven-day GP services may not be the first thing people reflect on when discussing former Prime Minister David Cameron’s legacy. But, like his gamble on Britain remaining in the EU, things have not quite gone according to plan.

Evidence from the pilots has shown patients are not very enthusiastic about seeing their doctor on a Sunday. And although the scheme does reduce A&E attendances, the costs have been shown to outweigh the savings by as much as 15 times.

access - seven-day - opening hours special report PPL - online

But it remains a political imperative and last month NHS England released its plan to implement seven-day services across the whole country. It will give all CCGs £6 per patient to implement seven-day GP access from 2019.

Pulse’s calculations indicate the whole exercise is expected to cost at least £1.5bn by the end of 2020/21.

But even with these figures, Mr Cameron’s original commitments will not be fulfilled. He had promised access to GPs ‘from 8am to 8pm, seven days a week’ at the Conservative party conference in 2014, but it is not what will be delivered.

NHS England specifies an additional 1.5 hours’ access on weekdays but no 8am to 8pm opening at weekends – only some level of prebookable and same-day appointments ‘on both Saturdays and Sundays to meet local population needs’. And appointments can be provided from a local hub rather than every practice opening at weekends (although to be fair to Mr Cameron, this was the reality of his policy from the start).

GPs have pointed out that the £6 per patient funding is way below the funding given to some of the pilot schemes that did provide 12-hour access every day of the week. For example, the pilot in Lambeth, south London, was given £9 per patient plus CCG funding.

So Mr Cameron may have only just moved on, but his dream of GPs seeing patients ‘from 8am to 8pm, seven days a week’ is already being watered down. And if CCGs wish to continue it, they will have to stump up more cash.

CCGs will need to cut their cloth according to this reduction in funding

GPC deputy chair Dr Richard Vautrey says: ‘It appears that NHS England has learned from the lessons of many of the pilots, which showed that there was little demand from patients for routine weekend appointments. There is importantly now no requirement to be open from 8am to 8pm on Saturdays and Sundays, with flexibility based on local needs.’

Dr Vautrey adds that the £6 per patient is ‘considerably less than many have received previously’ when the Government put £50m into pilot schemes in 2014, and £125m in 2015.

He says: ‘With a shortage of GPs and reduced funding, CCGs will also have to consider using other health professionals to provide these appointments.

‘CCGs will now need to cut their cloth according to this reduction in funding.’

And this is happening already. Dr Ross Dyer-Smith, a GP in Lambeth and principle spokesperson for the Lambeth GP federations, says their seven-day hub – which offers same-day urgent appointments – is already cutting back on services because funding has been reduced from £5m to £2m.

Although, swimming against the tide, NHS Lambeth CCG is commissioning further appointments on Sunday, even though there has been shown to be little demand.

Dr Dyer-Smith says: ‘The original service was 8am-8pm Monday to Friday and 10am-6pm Saturday and Sunday. Now it has gone down to 12-8pm Monday to Friday and 8am-8pm Saturday and Sunday. So we have reduced weekday opening and increased weekend opening.’

He adds: ‘That is based on Government policy and what the CCG requested based on the seven-day NHS pledge. Although actually we found that Sundays weren’t particularly heavily utilised, it has been very much a Government drive to increase that capacity at the weekend.’

Asked if he thinks that is the best use of the money, Dr Dyer-Smith says: ‘If I am honest, based on my experience of working in the hubs on those days, probably not.’

Leeds GP Dr Patrick Geraghty, who helped set up his local seven-day access hub, says it is working well, but only with significant CCG investment.

We are gambling on a new system when we don’t know whether it is going to work

Dr Geraghty says: ‘We know £6 per patient is not going to cover extended access from Monday to Sunday. At the moment, we are very lucky that NHS Leeds West CCG funds us £13.10 per patient on top of the NHS England funding. I don’t know what we would be able to offer from Monday to Sunday for £6 per patient. It wouldn’t be much of a service, to be honest.’

But others are more optimistic about the viability of their access schemes. David Pannell, chief executive of the Suffolk GP Federation, who has led a pilot, says: ‘It looks like quite generous funding, which I think will allow people to offer a good service – provided the service is done by quite a large group of practices. This is quite a big increase on what we received via the second wave of the GP Access Fund.

‘It will enable us to cover a much larger population with a very good service.’

But there is also an opportunity cost. And it sticks in the craw of many GPs that the NHS is planning to splash yet more cash on extended access, while they struggle to provide a safe service in core hours. As the House of Commons Health Committee has warned, the Government will be forced to foot the bill by making cuts elsewhere in the NHS budget.

Doncaster LMC medical secretary and GPC member Dr Dean Eggitt calls it an ‘appalling’ waste of money: ‘We are gambling on the prospect of a new system when we don’t know whether or not it is going to work.’

Dr Eggitt says this represents yet another inducement for GPs to move away from traditional surgeries and embrace ‘at scale’ working, in line with NHS England’s Five Year Forward View.

dr dean eggitt 3x2

Dr Dean Eggitt

He says: ‘I think the Government is hoping smaller practices will die out and bigger practices will naturally want to take on the bigger contracts with seven-day access. That will take several years of course, but I think that is the direction we are going.

‘And this kind of initiative is just one of the incentives to move us on in that direction. This money is being given to CCGs so they can then incentivise practices to work at scale and provide these sorts of services.’

And there is one big question that has not been answered: what will happen to the extended access DES? In 2015/16, 73% of practices received at least £1,000 via the DES, but Dr Eggitt says he expects this to disappear soon.

He says: ‘My personal expectation is that we are going to be moving more towards 8-8 contracts and the extended hours DES is going to be void and die out anyway.’ And so the GP access policy wheel keeps turning.

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Readers' comments (4)

I think even Mr Smith or Jones will understand that this 'investment' on seven days GP access is no new money. The House of Commons health committee clearly identified the claim of £10 billions going into NHS was entirely 'inaccurate'(I tried to avoid using the word 'hoax').These pilots should be renamed as propaganda instead .And the money is unlimited for propaganda e.g. US presidential campaigns , Chinese government's so called maintenance of stability . Of course , these 'pilots' are comparatively peanuts but important for the Tories to 'win the public over'.One would really like to see the breakdown of how all the money was spent in NHS and more importantly where have all the efficiency savings gone ? I think we all know it does not add up as proclaimed by the government . The latest news is statement from Academy of Royal Colleges to draw up a list of investigations and treatments that will be discouraged on NHS: 'Doctors name treatments that bring little or no benefit - BBC News'. This is fundamentally sound in terms of controlling demands and saving resources but my concern is always about educating the public with the right message and this task should be led by a responsible government . Do we have faith?But I suppose the government can still please the public by giving them back something called 7 days GP opening in return of this . Call me sinister !'Things are clearly not what they seem' as we always say. It is difficult to fathom how downwards this situation of NHS had gone without re-visiting what the 'still new' PM said in her party conference several weeks ago :'''.......Like the NHS – one of the finest health care systems anywhere in the world, and a vital national institution. An institution that reflects our values, our belief in fairness, and in which we all take enormous pride. And I mean all. Because there is complete cross-party support for the NHS. For its status as a provider of free-at-the-point-of-use health care. For the thousands of doctors and nurses that work around the clock to care for their patients. We all have a story about the nurse who cared for a loved one, or a surgeon who saved the life of a friend. So let us take this opportunity to say to those doctors and nurses – thank you. The NHS should unite us. But year after year, election after election, Labour try to use it to divide us. At every election since it was established, Labour have said the Tories would cut the NHS - and every time we have spent more on it. Every election, they say we want to privatise the NHS - and every time we have protected it. In fact, the party that expanded the use of the private sector in the NHS the fastest was not this party, but the Labour Party. The only party to ever cut spending on the NHS is not this party, but the Labour Party – that’s what they did in Wales. And at the last election, it wasn’t the Labour Party that pledged to give the NHS the money it asked for to meet its five-year plan – it was this party, the Conservative Party investing an extra £10 billion in the NHS – more than its leaders asked for and this year more patients are being treated, and more operations are being carried out, by more doctors and more nurses than ever before. That’s a tribute to everyone who works in the NHS. But also to one man – Jeremy Hunt – who is one of the most passionate advocates for patients and for the doctors, nurses and others who work in our health service that I have ever known. So let’s have no more of Labour’s absurd belief that they have a monopoly on compassion. Let’s put an end to their sanctimonious pretence of moral superiority. Let’s make clear that they have given up the right to call themselves the party of the NHS, the party of the workers, the party of public servants. They gave up that right when they adopted the politics of division. When their extreme ideological fixations led them to simply stop listening to the country. When they abandoned the centre ground. And let us take this opportunity to show that we, the Conservative Party, truly are the party of the workers… the party of public servants… the party of the NHS.......''

While she clearly took the opportunity to steal some good points from the leftists, she wasted no time to ridicule their pitfalls with swift aloofness. The Tory would be the 'nasty party' no more(the term she created while her party was in political wilderness those years) . And her party would be the party of the NHS etc.My verdict is ,simply , she needed this speech more than anybody else because she knew the reality was to bite her back very quickly . After all ,as I said above, politics is about winning the public over.But politics is also about winning over your colleagues .That is exactly where her honeymoon of premiership rapidly coming to the end of its lifespan . A godfather would always love his loyal lieutenants and try to wipe out the 'rats' . Trouble for Auntie right now is who are the lieutenants , who are the rats? (Superficially , one can see three rats already running around with one only wanted to be the PM in the first place).The complication comes from Brexit and had caused distractions on everything. Fundamentally, one has to question the PM seriously ,deep down, which way is she swinging or is she just an opportunist setting a target of being Thatcher 2.0? Friends or foes in her cabinet?The seat of the PM has never been more uncomfortable . One thing quite evident is she in the process of going separate way with her presumed closest lieutenant, the Chancellor , who is her first-class honour university alumnus. If immigration is the core of argument for Brexit , the economy is the counterpart for staying in European single market . One cannot have it all . The official dialogues about Brexit from these two so far had been contradictory , PM on immigration zone and the Chancellor on the economy. For us , the ideology of 'interim workforce' , the four year sentence of going nowhere for medical students after graduation and the eventually self-sufficient condition using only UK grown medical staff , see its daylight under the PM's version of 'hard Brexit'. Let's be honest , it is probably right to say : No Brexit , No May as the PM. But this put the Chancellor in the most embarrassing position and deep down, he really did not want this headache of leaving EU. The value of pound had gone as expected and history told us currency depreciation is not instantaneously disastrous and I can understand why Mervin King's immediate comment was a welcoming one. But the question is 'what 's next?'. The mentality of the government is somehow it could still 'convince' the EU for agreeing something like a happy medium as well as striking good deals with other countries, China, US etc. But the current failure of striking a trade deal between EU and Canadian government tells you about the reality. The irony is probably half of those who had voted to leave EU still want to stay in the single market .The 'deadline' as the story goes , is destined on 1st April next year when the PM , as announced, will invoke article 50.As many economists suggested , the solution to this mess appeared to be a Keynesian approach : the government has to exert more fiscal power as the Bank of England had already done what it could do in quantitative easing . This entails more infrastructure investment etc. and it means more borrowing and more ruthless savings from somewhere.It is impossible to reach a surplus by 2020 which was the obsession as well as bargaining chip to be the next PM as far as the ex-Chancellor was concerned.In effect, this situation was a good slap on his face but obviously the circumstances are completely new now.However, that also has ridiculed the infamous £350 millions to be injected into NHS weekly . Instead , we have STP(sustainability and transformation plan) on our plate . While globalisation has been widely condemned for the economic mess we are in,big establishment(e.g.UK)wants to break away from massive one(e.g.EU),small(e.g. Scotland )away from big one and smaller from small one and it goes on.The irony is we ,GPs, are queuing up for super or mega-practices .All the evidences and many feedbacks from NHS executives had suggested STP would be mission impossible . The whole ideology boils down from the top pushing for less hospital beds or even hospital closures , poorly thought-through transfer of workload from secondary to primary care with questionable funding , rationing through the back-door but the most stifling part is perhaps this interim workforce and eventual self sufficiency serving the PM's agenda of pleasing the school of immigration control .Yes, the honeymoon is certainly over as soon as both the PM and Chancellor told Simon Stevens in private conversation that there was no extra money into NHS and one could only see half of the £10 billions supposed to go into NHS by 2020 , according to the health committee of the House of Commons. In fact , one would wonder whether Simon would be still in position if he insisted to implement his five year forward plans(NHS and GP) .I was reading a very interesting article on The Economist about why Hillary Clinton has been so unpopular even though Trump's reputation is going down the drain:http://www.economist.com/news/united-states/21709053-americas-probable-next-president-deeply-reviled-why-hating-hillary

Its conclusion was largely down to sexism . I can understand the reasons why May wanting to be Thatcher 2.0 while you are sitting in a cabinet with a lot testosterone flying around and fundamentally your party is a right winged one. But who is to be mattering the most , your colleagues, hence , party OR the country ?

gosh Vinci how do you find the time?I'm thinking about a new way of dividing healthcare. No longer 'primary' and 'secondary'care but 'diagnosis' and 'treatment'. Because market forces can reduce the costs of treatments and patients can decide what treatments are worth their own money (or insurance premiums). Diagnosis should always be free on the NHS and impartial, unbiased and with evidence-based advice on treatment options. The NHS is and always will be the best in the world at the latter. But a lot of treatments aren't worth the cost and patients and the Govt and healthcare insurers need to learn about this.